BOOKS OF THE TIMES

BOOKS OF THE TIMES;AIDS After Randy Shilts: Still Blame Enough for All

By MICHIKO KAKUTANI

Published: December 1, 1995

THE GRAVEST SHOW ON EARTH America in the Age of AIDS By Elinor Burkett 399 pages. Houghton Mifflin Company. $24.95

Elinor Burkett's impassioned new book, "The Gravest Show on Earth: America in the Age of AIDS," takes up where Randy Shilts's 1987 study, "And the Band Played On," left off. Mr. Shilts argued that "AIDS did not just happen to America -- it was allowed to happen" by the initial failure of doctors, scientists, government bureaucrats and leaders of gay groups to mobilize "the way they should in a time of threat."

Ms. Burkett, a former reporter for The Miami Herald, similarly argues in her book that the AIDS problem has been made worse by human failure: by "politics, greed and utter stupidity" and by society's "failure to treat AIDS as a disease, pure and simple."

"I began to see AIDS as a lens through which the flaws of the nation were magnified," she writes. "It revealed America's need to blame someone rather than to accept tragedy and cope with the truth of our relative powerlessness against nature. It shone a light on Americans' need to define themselves by membership in victim groups, competing for most-victimized status and the financial and psychic benefits that carried. AIDS provided a glimpse of a society more comfortable with fairy-tale villains -- human or viral -- than the reality of sluggish scientific progress and the complex interaction between behavior and infectious agents."

Although Ms. Burkett rehashes the life stories of Kimberly Bergalis, a college student, and the MTV star Pedro Zamora, she devotes relatively little space in this volume to case studies. For the most part, she focuses instead on the politics and economy of AIDS: on the infighting between AIDS action groups, on intramural debates about the direction AIDS research should take and on the cozy relationship between large pharmaceutical companies and Government bureaucrats.

Writing in quick, feisty prose, Ms. Burkett makes her own positions crystal clear, and in some cases they are positions that are bound to provoke heated debate. She accuses both the Christian right and leaders of gay groups of "waging competing jihads," of claiming the moral high ground while "slinging blame and attempting to legislate their own versions of political correctness." She contends that African-American leaders "acted like ostriches" during much of the 80's, instead of working on AIDS prevention and education. And she argues that the AIDS lobby has received "a level of Federal attention, support and services that were the envy of people with cancer, multiple sclerosis and heart disease."

Because AIDS is "the most politicized disease in human history," Ms. Burkett observes, health-care agendas and plain common sense often get caught in the political crossfire. When Dr. Stephen C. Joseph, a former New York City Health Commissioner, announced plans to distribute a million condoms, he was assailed for endorsing promiscuity by a spokesman for John Cardinal O'Connor; and when he suggested implementing some sort of system for partner notification (a standard public health procedure used to help contain tuberculosis, syphilis and hepatitis), he was assailed by people intent on preserving the principle of confidentiality.

A member of the New York State Assembly, Nettie Mayersohn of Queens, Ms. Burkett reports, similarly found herself condemned by both the left and the right when she introduced a bill requiring that all newborn infants be tested for H.I.V. and that all parents of H.I.V.-positive infants be notified of the results. Routine testing of pregnant women for H.I.V., after all, is opposed not only by women's groups like NOW (not to mention most AIDS lobbyists) but also by abortion opponents who worry that infected women might decide to terminate their pregnancies.

As local, state and Federal agencies dispense more and more money to fight the epidemic, political infighting has begun to afflict the very groups organized to help AIDS patients. "States fought with states over who was the hardest hit by the disaster," Ms. Burkett writes. "Cities argued with states over control of the funds. Municipal officials battled community organizations over how to divide up the spoils. Blacks and gays traded charges of homophobia and racism. Amid the court battles and screaming matches, everyone complained that the Federal Government wasn't handing out enough."

Money, in fact, plays a large role in this book, for Ms. Burkett argues that AIDS has become "a multi-billion-dollar growth industry," offering scientists a chance to make their name and drug companies and entrepreneurs an opportunity to make a fortune. This is more than simply a matter of competing for the millions of dollars the Federal Government annually spends for AIDS research; it's also about scientific reports bolstering the stock prices of multinational drug companies, an expanding job market for bereavement counselors and benefits coordinators, and the proliferation of new businesses catering to the needs of the ill and the fears of the healthy.

Condom makers, mail-order drug companies, home health-care services, vitamin and health-food stores have all benefited from the AIDS epidemic, Ms. Burkett says, as have a host of more unsavory enterprises, including trading card manufacturers (selling cards emblazoned with the likenesses of Magic Johnson, Arthur Ashe and Rock Hudson, among others) and plain old charlatans selling phony cures and false hopes.

"Even in the midst of recessions," Ms. Burkett writes, "there are few cutbacks in the industry that is AIDS. No layoffs are expected for those who make their living off the imminent demise of 40 million citizens of the planet."

Although Ms. Burkett writes with enormous energy and genuine outrage on behalf of AIDS patients who have been caught up in the AIDS bureaucracy, she displays a tendency to make broad -- and sometimes distorting -- generalizations that undermine her many valid points. In one chapter, she writes that "shooting galleries had become to black Americans what bathhouses had become to gay Americans."

In another chapter, she suggests that had the AIDS epidemic perhaps surfaced at another time in American history when the country "still maintained its innocence, its belief in its ability to solve all the great problems, the history of the epidemic would have been different," as though the fact that the disease first appeared to be an affliction of gay men did not have something to do with the slow response of mainstream scientists and physicians, as though sheer will and faith could have affected the course of a disease.

In fact, Ms. Burkett's main point in this book remains important: "AIDS is not caused by avarice, indifference, opportunism, careerism or homophobia," she writes. "As best we know, it is caused by a virus (from the Latin for 'poison'), an exquisitely primitive form of life that does not care about politics, money or the Nobel Prize. A virus is programmed to care about only one thing: survival."